Fitting a gastric ring constitutes one of the techniques that have been developed for combating massive obesity from which an increasing number of people are suffering in developed countries.
Compared with other techniques, such as gastric bypass (BPG), or vertical banding gastroplasty (VGB), fitting a gastric ring presents the advantage of not changing the anatomy of the patient. Its principle is to reduce the diameter of the stomach opening, creating an anterior pocket of volume that is small so that the patient has a sensation of being sated after ingesting a minimal quantity of food.
Since its appearance in 1986, several models of gastric ring have been proposed that are suitable for being implanted by laparoscopic surgery. Nevertheless they all have structure that is substantially similar. They comprise a certain length of relatively narrow band made of a material that is sufficiently flexible to be capable of being looped, said band being provided with closure means acting between its distal and proximal ends. In addition, adjustment means suitable for being externally actuated enable the inside diameter of the gastric ring to be adjusted, once it has been put into place.
In the ring known as a Lap Band® or as LAGB®, the adjustable nature is obtained by an inside section of the ring being inflatable, said section being the part that is to come into contact with the stomach. A connection tube connects said inflatable section to a so-called “injection port”. When the ring is put into place, the connection tube and the connection part are permanently implanted inside the patient's body, with the injection port being easily accessible. While the ring is being put into place, it is at minimum inflation. Its diameter is adjusted by injecting the inflation fluid into the injection port.
The gastric ring known as the Swedish Adjustable Gastric Band SAGB® differs from the Lap Band® mainly by its closure system which consists in a system having a tongue with a safety catch, the ring being closed by pulling on said tongue until the safety catch is reached. The ring known under the name Heliogast® differs from the first two likewise by its closure system which makes use of hydraulic locking.
In spite of its recognized effectiveness, in terms of loss of weight, the gastric ring technique is not without drawbacks, in particular due to the complications that can arise.
Some of these complications are associated with the presence of the injection port which might be faulty, and with the connection tube which might rupture. According to a recent study, more than 8% of the observed complications are due to those two causes. Changing the injection port requires further surgery under general anesthetic. A rupture in the connection tube requires further laparoscopic surgery.
The injection port may also be the seat of acute or chronic suppuration.
Finally, in terms of appearance, implanting the injection port leaves a scar that is 5 centimeters (cm) to 6 cm long.
Other known complications of the gastric ring technique consist in a phenomenon whereby the ring migrates in the gastro-gastric wall, and also in a phenomenon whereby the wall of the stomach slides through the ring. Even though some complications of this kind can occur soon after the ring has been implanted, most of them appear in the medium term, after several years.